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What’s the difference between a $77 and a $635 cavity?


Dental insurance has changed and it can save you a lot of money.

What would you do with an extra $4,000 in your pocket?

That’s probably the last thing you think when given the chance to buy a dental insurance plan. But beyond better health for your mouth, dental insurance means better health for your wallet too. 

As anyone who has paid a dentist’s bill out of pocket knows, even a routine visit with a dentist for a check-up, cleaning, and set of x-rays can quickly approach $500. A good dental plan costing $30-40 per month covers not just those costs, but protects you from the big bills that come from a major oral health event — a tooth abscess, root canal, crown, or cap.

Dental Insurance by the Numbers – A Tale of Two Cavities

Harry and Larry are your typical Jersey guys.

Harry is a 22-year-old whose smile lights up a room.  He has Family Grins Plus — one of Horizon’s most popular comprehensive dental plans. His coverage1 pays for preventive/diagnostic services, like exams, x-rays and cleanings.  It also covers more major dental expenses like fillings and crowns, dental surgery, bridges and dentures.

Harry pays $33.40 per month, or $401.88 per year, for this plan.

Larry, also 22, takes his chances without dental coverage, preferring to pay out-of-pocket to keep his million-dollar smile healthy.

Harry sees his dentist once or twice a year for check-ups and exams to check for cavities and other telltale signs of an emerging problem. When Harry completes his visit, he pays $0 out-of-pocket.

When Larry goes for the same routine visit, his out-of-pocket cost is $414.32.2

Both patients can say they paid about $400 over a year for dental services.

After being problem-free for a year, though, Harry and Larry both pick up a couple of cavities that require fillings.

Larry is handed a bill for $635.08, representing his full out-of-pocket responsibility for filling two cavities.

For Harry, Family Grins Plus covers 80%, meaning that his out-of-pocket share comes to $77.65.

If Larry decides that $635.08 is more than he can or wants to pay for his dental work, the cavities in his mouth would eventually become larger and could infect the nerve in his tooth, which requires a root canal procedure.

Without insurance coverage, that root canal would cost Larry $1,452.83, or more than double what he would have paid out of pocket to fill the two original cavities.

We think Harry, with his full coverage, would have been able to dodge the root canal bullet by seeing the dentist for his routine cleanings, check-ups and maintenance. But, if Harry also needed a root canal, his plan would cover 50% for an in-network dentist, or an out-of-pocket expense of $631.12.

If people postpone treatment or neglect their teeth — this is the typical clinical situation they find themselves in.

Typically, a root canal requires further restoration to preserve the integrity of our teeth. The restoration means that dentists insert posts and crowns into the infected tooth or teeth.

So, Larry’s out-of-pocket expenses for these additional but necessary services will rise to $3,298.83.

With Harry’s coverage at 50%, his out of pocket cost would come to $1,412.68

To review side by side, here are Harry and Larry’s costs, with and without insurance:

Yearly cost of dental coverage:$402Yearly cost of dental coverage:$0
Dental exam:$0Dental exam:$414
Fillings for 2 cavities:$77Filling 2 cavities:$635
Root canal:$731Root canal:$1,453
Posts and crowns:$1,412Posts and crowns:$3,299
Total with insurance:$2,622Total w/o insurance:$5,801

“Oral health is as important as any other part of your overall health,” said Joan Monaco, DMD, Director of Horizon’s Dental Operations. “Keeping your smile healthy through dental coverage and regular visits not only makes economic sense, but is a wise investment in your long term wellness and quality of life.” 

If you have questions, need to find a dentist or are seeking more information about oral health for you or your family, visit Horizon Dental.

  1. Based on 2020 Plan Guide rates
  2. Based on 2020 statewide NJ average of submitted fees